The birth control gap

The state of Texas will do nothing to address this as long as the current government is in place.

Ramírez’s situation reflects an immense need in the country: 21 million women of reproductive age needed publicly funded contraceptive care as of 2016, according the Guttmacher Institute. Demand is expected to increase in states like Texas, where strict abortion laws mean many people, mostly in poor communities of color, now will have to carry pregnancies to term.

But Texas is ill prepared, healthcare advocates and policy experts warn. Significant policy changes and funding cuts over the last decade make it more difficult for low-income patients to access contraceptives, threatening to worsen the already poor maternal health outcomes in the state.

“A lot of this (new) legislation is focused on protecting the rights of the unborn, but we need to be equally focused on protecting the rights of women and their ability to make decisions about their health,” said Dr. Rola El-Serag, director of the Baker Institute’s Center for Health and Biosciences at Rice University and former expert educator in women’s health with the Department of Veterans Affairs.


Planned Parenthood Gulf Coast, which covers eight clinics in the greater Houston region, has seen a 67 percent increase in patients seeking long-term reversible contraceptives, such as IUDs and implants, according to a spokesperson.

Legacy Community Health, the largest federally qualified health center in Texas, and the four family planning clinics operated by the Houston Health Department also have experienced a surge of interest in long-acting contraceptives, officials told the Chronicle. Other news outlets have reported similar trends elsewhere in the state.

“Anecdotally, I can tell you, now women are taking family planning a lot more seriously, because they know an unplanned pregnancy is not going to be something that they can easily mitigate,” said Dr. Devanshi Somaiya, chief of family planning for the Houston Health Department.

Clinics are facing this growing interest after a decade of significant changes to the state’s family planning programs. Family planning includes contraceptive access as well as pregnancy testing, counseling and STD testing.

In 2011, the legislature slashed the family planning budget dramatically, from $111 million to $38 million, and made it harder for Planned Parenthood and other specialized family planning organizations to access the remaining funds, according to the researchers at the Texas Policy Evaluation Project based at the University of Texas at Austin.

As a result, 82 clinics across Texas closed or stopped providing family planning services, and fewer organizations provided IUDs, implants and female sterilization and vasectomy due to high costs.

Lawmakers reinstated funding over the next several years, which helped some providers rebuild services, while continuing to steer money away from Planned Parenthood, which serves a disproportionately high share of family planning patients. Even as funding stabilized, the state has struggled to fill coverage gaps and has consistently declined to expand Medicaid coverage.

Uninsured and publicly insured women commonly report issues paying for care, finding a provider that accepts their insurance and locating providers that offer the services they need, according to the policy evaluation project. Research also shows most women in that population are not using their preferred birth control method. Meanwhile, the state continues to boost funding for an anti-abortion program that supports faith-based pregnancy centers, which generally do not offer contraceptives.

The record speaks for itself. There will be nothing done to address this problem as long as the Republicans are in charge. This is one of those times where I don’t feel the need to embellish the argument. The facts are as plain as day.

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